Citation NR: 9739641
Decision Date: 11/28/97 Archive Date: 12/03/97
DOCKET NO. 95-27 563 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Louisville,
Kentucky
THE ISSUES
1. Entitlement to service connection for arthritis of
multiple joints.
2. Entitlement to service connection for high blood
pressure.
3. Entitlement to service connection for bilateral hearing
loss.
4. Entitlement to an increased (compensable) evaluation for
renal lithiasis.
REPRESENTATION
Appellant represented by: Paralyzed Veterans of America,
Inc.
ATTORNEY FOR THE BOARD
William D. Teveri, Associate Counsel
INTRODUCTION
The veteran served on active duty from February 1969 to
February 1971.
This appeal arises from a July 1995 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
Louisville, Kentucky.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran essentially contends that the RO was incorrect in
not granting the benefits sought on appeal. The veteran
maintains, in substance, that he currently suffers from
arthritis of multiple joints, high blood pressure, and a
bilateral hearing loss, which had their onset during service,
and that his renal lithiasis is more severe than the
noncompensable evaluation currently assigned. Therefore,
favorable determinations have been requested.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the veteran has not met the
initial burden of submitting evidence sufficient to justify a
belief by a fair and impartial individual that his claims for
service connection for arthritis of multiple joints, high
blood pressure, and bilateral hearing loss are well grounded,
and that the preponderance of the evidence is against an
increased (compensable) evaluation for the veteran’s service-
connected renal lithiasis.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran’s appeal has been obtained by the
RO.
2. There is no competent evidence of arthritis of any joint
in service, and there is no medical evidence of arthritis
being manifested to a compensable degree within one (1) year
of the veteran’s discharge from service.
3. There is no medical evidence of a nexus between any
currently diagnosed arthritis of the cervical spine and an
in-service injury or disease or any other incident of
service, and no competent medical evidence of a current
diagnosis of arthritis of any other area of the body.
4. There is no competent medical evidence of high blood
pressure in service, or medical evidence of a nexus between
any currently diagnosed hypertension and the veteran’s
military service.
5. There is no medical evidence of a nexus between any
currently diagnosed hearing loss and an in-service injury or
disease or any other incident of service.
6. The veteran’s renal lithiasis is manifested by objective
findings of history of renal stones with surgery, but no
current active disease process or symptomatology.
CONCLUSIONS OF LAW
1. The veteran’s claim for service connection for arthritis
of multiple joints is not well grounded. 38 U.S.C.A. §
5107(a) (West 1991).
2. The veteran’s claim for service connection for high blood
pressure is not well grounded. 38 U.S.C.A. § 5107(a) (West
1991).
3. The veteran’s claim for service connection for bilateral
hearing loss is not well grounded. 38 U.S.C.A. § 5107(a)
(West 1991).
4. The criteria for a compensable rating for renal lithiasis
have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991);
38 C.F.R. §§ 4.1-4.14, 4.20, 4.31, 4.115b, Diagnostic Codes
7508, 7509 (1996).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Service Connection
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by service.
38 U.S.C.A. §§ 1110 (West 1991); 38 C.F.R. § 3.303(a) (1996).
Where a veteran served continuously for 90 days or more
during a period of war or during peacetime service after
December 31, 1946, and an organic disease of the nervous
system (sensorineural hearing loss), arthritis, or
hypertension becomes manifest to a degree of 10 percent
within 1 year from date of termination of such service, such
disease shall be presumed to have been incurred in service,
even though there is no evidence of such disease during the
period of service. This presumption is rebuttable by
affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101,
1112 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1996).
With chronic disease shown as such in service (or within the
presumptive period under § 3.307) so as to permit a finding
of service connection, subsequent manifestations of the same
chronic disease at any later date, however remote, are
service connected, unless clearly attributable to
intercurrent causes. This rule does not mean, in pertinent
part, that any manifestation of joint pain in service will
permit service connection of arthritis, first shown as a
clear-cut clinical entity, at some later date. For the
showing of chronic disease in service, there is required a
combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or a diagnosis including the word “chronic.” When
the disease identity is established, there is no requirement
of evidentiary showing of continuity. Continuity of
symptomatology is required only where the condition noted
during service (or in the presumptive period) is not, in
fact, shown to be chronic, or where the diagnosis of
chronicity may be legitimately questioned. When the fact of
chronicity in service is not adequately supported, then a
showing of continuity after discharge is required to support
the claim. 38 C.F.R. § 3.303(b) (1996). As there is no
indication that any of the claimed disabilities are combat-
related, consideration of the provisions of 38 U.S.C.A. §
1154(b) (West 1991); 38 C.F.R. § 3.304(d) (1996) are is not
for application. Neither the veteran nor his representative
contend otherwise.
The initial question which must be answered in this case is
whether the veteran has presented a well grounded claim for
service connection. In this regard, the veteran has “the
burden of submitting evidence sufficient to justify a belief
by a fair and impartial individual that the claim is well
grounded;” that is, the claim must be plausible and capable
of substantiation. See 38 U.S.C.A. § 5107(a); Murphy v.
Derwinski, 1 Vet. App. 78, 81 (1990).
In order for a claim to be well grounded, there must be
competent evidence of current disability (established by
medical diagnosis), see Brammer v. Derwinski, 3 Vet.
App. 223, 225 (1992) and Rabideau v. Derwinski, 2 Vet.
App. 141, 144 (1992); of incurrence or aggravation of a
disease or injury in service (established by lay or medical
evidence), see Layno v. Brown, 6 Vet. App. 465, 469 (1994)
and Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991); and of
a nexus between the in-service injury or disease and the
current disability (established by medical evidence), see
Lathan v. Brown, 7 Vet. App. 359, 365 (1995) and Grottveit v.
Brown, 5 Vet. App. 91, 93 (1993). Medical evidence is
required to prove the existence of a current disability and
to fulfill the nexus requirement. Lay or medical evidence,
as appropriate, may be used to substantiate service
incurrence. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995)
and Layno, 6 Vet. App. at 469.
The United States Court of Veterans Appeals (Court) has also
established rules for the determination of a well grounded
claim based upon the chronicity and continuity of
symptomatology provisions of 38 C.F.R. § 3.303(b). The Court
has ruled that the chronicity provision of § 3.303(b) is
applicable where evidence, regardless of its date, shows that
a veteran had a chronic condition in service or during an
applicable presumption period and still has such condition.
Such evidence must be medical unless it relates to a
condition as to which, under the Court’s case law, lay
observation is competent. If the chronicity provision is not
applicable, a claim may still be well grounded or reopened on
the basis of § 3.303(b) if the condition is observed during
service or any applicable presumption period, continuity of
symptomatology is demonstrated thereafter, and competent
evidence relates the present condition to that
symptomatology. See Savage v. Gober, No. 94-503, slip. op.
at 15 (U.S. Vet. App. Nov. 5, 1997).
A. Arthritis of multiple joints
The veteran’s service medical records contain no indication
of any complaints of, treatment for, findings of, or
diagnosis of arthritis, or arthritis of multiple joints. The
veteran’s May 1968 pre-induction Report of Medical History
indicated that he reported a history of swollen or painful
joints, and in the narrative portion of this report, it was
indicated that the veteran had a history of minor sprains of
the neck. However, his contemporaneous Report of Medical
Examination noted no musculoskeletal or joint abnormalities
upon physical examination. An April 1969 medical report
indicated that the veteran was conservatively treated for a
sprained ankle. There are no follow-up reports, however. In
January 1970, the veteran complained of pain in his neck
since an October 1969 accident. As cold pack was
administered. An X-ray report presumably accomplished in
conjunction with this treatment noted a history of a sports
injury which had existed prior to service; no fracture of the
cervical spine was noted. No further treatment was reported,
and on the veteran’s October 1970 separation Report of
Medical Examination, the veteran did not report a history of,
nor did the examiner find, arthritis to be present.
The record indicates that the veteran underwent VA
examinations in May 1971 and in May 1972, at which the time,
the examiner indicated that the veteran’s musculoskeletal
system was normal.
The veteran has also submitted private medical records from
October 1986 through March 1995; however, these records show
a diagnosis of lumbar scoliosis, possibility positional, in
November 1986, and osteoarthritis of the cervical spine in
January 1995. The veteran was also treated for episodes of
low back strain in 1991 and 1993. None of these records
include a diagnosis of arthritis of any other area of the
body other than the cervical spine. The Board notes that the
veteran in his notice of disagreement stated that he had a
“crooked spine when he went into the service.” It is unclear
as to whether the veteran is referring to the lumbar or
cervical spine. In an event, the Board notes that even if
the veteran is implying that some preexisting disability of
the spine was aggravated in service, he, as a lay person, has
not been shown to possess the medical expertise necessary to
render a diagnosis of arthritis in service or to establish a
nexus between a currently diagnosed disorder and service.
See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v.
Derwinski, 2 Vet. App. 492, 494-95 (1991). Although the
veteran was treated in service for neck pain on one occasion,
there is no medical evidence that demonstrates that the
veteran’s neck disorder was chronic in service or during the
one-year presumptive period for arthritis. Medical evidence
is needed in this case to provide a causal nexus between the
veteran’s service and cervical spine arthritis. Further,
even if it is assumed that the provisions of 38 C.F.R.
§ 3.303(b) regarding post-service continuity of
symptomatology have been met at least with respect to the
veteran’s cervical spine, medical expertise is required to
relate the veteran’s present arthritis of the cervical spine
to any claimed post-service symptoms. Therefore, his lay
contentions, alone, do not provide a sufficient basis upon
which to find his claim to be well grounded. See Grottveit
v. Brown, 5 Vet. App. at 93. Well grounded claims must be
supported by evidence, not merely allegations. Tirpak v.
Derwinski, 2 Vet. App. 609, 611 (1992). In the absence of
competent medical evidence to support the appellant’s claim
for service connection for arthritis of multiple joints, the
claim must be denied as not well grounded.
B. High blood pressure
The veteran’s service medical records contain no indication
of complaints of, treatment for, findings of, or diagnosis of
hypertension, to include high blood pressure. His May 1968
Report of Medical History noted that he reported having had
in the past palpitation or pounding heart, but his
contemporaneous Report of Medical Examination noted no
cardiovascular problems, high blood pressure, or palpitation
or pounding heart upon examination. On his induction
examination report his blood pressure was found to be 114/82,
and on his October 1970 separation examination report it was
found to be 130/64. Another reading, in December 1970, was
128/70. The veteran did not report a history of
hypertension, to include high blood pressure, at that time.
On post-service VA examination in May 1971, the veteran’s
blood pressure was reported to be 110/80; on VA examination
in May 1972, a blood pressure reading of 120/80 was recorded.
VA examination in December 1973 included a blood pressure
reading of 108/68.
Private medical records dated in November 1986 include a
blood pressure reading of 130/90. Additional private medical
records show a diagnosis of hypertension beginning in
February 1987, and treatment for such from that date through
1995.
The Board notes that although the veteran has reported that
he has had high blood pressure since service, the veteran has
submitted no competent medical evidence relating his current
diagnosis of hypertension to his service. Further, the Board
finds that medical evidence is needed in this case to
demonstrate the existence in service or in the presumptive
period of hypertension as high blood pressure is the type of
disability that requires medical expertise to demonstrate its
existence; lay evidence is simply not competent to identify
the existence of high blood pressure or hypertension. There
is no evidence that the veteran had a chronic disease
related to high blood pressure in service or hypertension
during the presumptive period. Further, the veteran has
presented no competent evidence which provides a causal nexus
between the veteran’s service and the current diagnosis of
hypertension.
As previously noted, a well grounded claim in this case
requires competent medical evidence of a nexus between an in-
service injury or disease and that disability in order to be
plausible, or evidence meeting the criteria of 38 C.F.R.
§ 3.303(b). In the absence of such evidence, the veteran’s
claim for service connection for high blood pressure, must be
denied as not well grounded.
C. Bilateral hearing loss
The veteran contends that he had a bilateral hearing loss
during service, and currently suffers from the same
disability.
The veteran’s May 1968 pre-induction examination report
indicates that an audiological evaluation found pure tone
thresholds, in decibels, as follows:
HERTZ
500
1000
2000
3000
4000
RIGHT
25
15
5
5
15
LEFT
15
15
0
5
35
A notation on this report indicates that the veteran had
defective hearing, and he was given a number 2 physical
profile for hearing.
The veteran’s October 1970 discharge examination report
indicates that an audiological evaluation found pure tone
thresholds, in decibels, as follows:
HERTZ
500
1000
2000
3000
4000
RIGHT
15
10
10
X
20
LEFT
15
10
15
X
20
The only evidence submitted by the veteran subsequent to his
discharge from service is a statement from his employer,
dated in May 1995, some twenty-four years after his
discharge, which apparently was provided to the veteran, and
which indicated that a recent hearing test revealed a
moderate loss in hearing. The statement continued that a
moderate loss of hearing occurred when the average level in
hearing is greater than 40 decibels in either ear. The
statement further advised the veteran to see a hearing
specialist, and to wear appropriate hearing protection.
Service connection for hearing loss is circumscribed by
38 C.F.R. § 3.385 (1996), as follows:
For purposes of applying the laws
administered by VA, impaired hearing
will be considered to be a
disability when the auditory
thresholds in any of the frequencies
500, 1,000, 2,000, 3,000, or 4,000
hertz, is 40 decibels or greater; or
when the auditory thresholds for at
least three of the frequencies, 500,
1,000, 2,000, 3,000, or 4,000 are 26
decibels or greater; or when speech
recognition scores using the
Maryland CNC Test are less than 94
percent.
Based on the evidence of record, and applying 38 C.F.R.
§ 3.385, the veteran clearly did not experience any
documented hearing loss for VA purposes during active
service. However, the lack of any evidence of hearing loss
disability in service or at separation is not fatal to the
veteran’s claim. Laws and regulations do not require in-
service complaints of or treatment for hearing loss in order
to establish service connection. See Ledford v. Derwinski, 3
Vet. App. 87, 89 (1992). The key issues are whether the
veteran currently satisfies the criteria of 38 C.F.R.
§ 3.385, and whether there is medical evidence linking the
current hearing loss disability to the veteran’s period of
active service. As noted by the United States Court of
Veterans Appeals (Court):
Where the regulatory threshold
requirements for hearing disability are
not met until several years after
separation from service, the record must
include evidence of exposure to disease
or injury in service that would adversely
affect the auditory system and post-
service test results meeting the criteria
of 38 C.F.R. § 3.385....For example, if
the record shows (a) acoustic trauma due
to significant noise exposure in service
and audiometry test results reflecting an
upward shift in test thresholds in
service, though still not meeting the
requirements for a “disability” under
38 C.F.R. § 3.385, and (b) post-service
audiometry testing produces findings
meeting the requirements of 38 C.F.R.
§ 3.385, rating authorities must consider
whether there is a medically sound basis
to attribute the post-service findings to
the injury in service, or whether they
are more properly attributable to
intercurrent causes.
Hensley v. Brown, 5 Vet. App. 155, 159 (1993) (quoting from a
brief of the VA Secretary).
Unfortunately, however, the evidence of record does not meet
the test of the Hensley case. The veteran’s service medical
records not only do not indicate audiometry test results
reflecting an upward shift in test thresholds in service, but
rather, actually indicate a downward shift. The pure tone
thresholds of the two in-service examinations do not meet the
criteria of § 3.385, and the veteran has submitted no medical
evidence of a nexus, or relationship, between any currently
diagnosed bilateral hearing loss and his military service.
There is also no evidence in the veteran’s service personnel
or medical records indicating that he was exposed to acoustic
trauma during his military service. Finally, the above being
the case, it also follows that 38 C.F.R. § 3.303(b) is not
for application.
As previously noted, a well grounded claim requires competent
medical evidence of a nexus between an in-service injury or
disease and a current disability in order to be plausible, or
evidence meeting the criteria of 38 C.F.R. § 3.303(b). In
the absence of such evidence, the veteran’s claim for service
connection for bilateral hearing loss must be denied as not
well grounded.
D. Conclusion
Since Board has determined that the veteran’s claims for
service connection for arthritis of multiple joints, high
blood pressure, and bilateral hearing loss, are not well
grounded, the VA has no further duty to assist the veteran in
developing the record to support such claims for service
connection. See Epps v. Gober, No. 97-7014, slip op. at 10-
11, (U.S. Ct. App. Fed. Cir. Oct. 7, 1997) (“there is nothing
in the text of § 5107 to suggest that [VA] has a duty to
assist a claimant until the claimant meets his or her burden
of establishing a “well grounded” claim.”)
The Board recognizes that this appeal is being disposed of in
a manner that differs from that used by the RO. The RO
denied the veteran’s service connection claims on the merits,
while the Board has concluded that the claim is not well
grounded. However, the Court has held that “when an RO does
not specifically address the question whether a claim is well
grounded but rather, as here, proceeds to adjudication on the
merits, there is no prejudice to the veteran solely from the
omission of the well grounded analysis.” See Meyer v. Brown,
9 Vet. App. 425, 432 (1996). The Board further notes that
the difference between evidence required to render a claim
well grounded and that required to reopen a previously
disallowed claim appears to be slight. See Edenfield v.
Brown, 8 Vet. App. 384, 390 (1995) (en banc).
The Board views its discussion as sufficient to inform the
veteran of the elements necessary to complete his application
for a claim for service connection for the claimed
disabilities. See Robinette v. Derwinski, 8 Vet. App. 69,
77-78 (1995).
II. An increased evaluation for renal lithiasis
Initially, the Board finds that the veteran’s claim is well
grounded within the meaning of 38 U.S.C.A. § 5107(a). That
is, the veteran is found to have presented a claim which is
not inherently implausible, inasmuch as a mere allegation
that a service connected disability has increased in severity
is sufficient to establish an increased rating claim as well
grounded. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994);
Proscelle v. Derwinski, 2 Vet. App. 629, 623 (1992).
Further, after examining the record, the Board is satisfied
that all relevant facts have been properly developed in
regard to his claim and that no further assistance to the
veteran is required to comply with the duty to assist, as
mandated by 38 U.S.C.A. § 5107(a).
Additionally, in accordance with 38 C.F.R. §§ 4.1-4.2 (1996)
and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board
has reviewed the veteran’s service medical records and all
other evidence of record pertaining to the history of the
veteran’s renal lithiasis, to include kidney stones. The
Board has found nothing in the historical record which would
lead to a conclusion that the current evidence on file is
inadequate for proper rating purposes.
In determining a rating for a disability, the Board may only
consider those factors which are included in the rating
criteria provided by regulations for rating that disability.
To do otherwise would be legal error as a matter of law.
Massey v. Brown, 7 Vet. App. 204, 208 (1994); Pernorio v.
Derwinski, 2 Vet. App. 625, 628 (1992).
The veteran was service connected for renal lithiasis by a
July 1971 rating decision. The assignment of a 10 percent
evaluation was made at that time. A note contained in the
decision indicated that due to the acute nature of the
condition an examination was “scheduled for one year.” A
June 1972 decision noted that evidence showing a small stone
outside the veteran’s ureter had been received, and that the
current evaluation was to be continued until an examination
in eighteen months from that date. Based upon a December
1973 VA nephrology examination report a January 1974 rating
decision reduced the veteran’s evaluation from 10 percent
disabling to noncompensable.
The veteran has submitted private hospitalization and
treatment reports for the period from October 1986 through
March 1995, which reveal that the veteran was hospitalized in
November 1986 when he complained of left flank pain. The
diagnosis was left renal colic, and the veteran underwent
extraction. A March 1991 report noted that examination
revealed a normal upper urinary tract. A February 1995
report noted that the veteran complained of left flank area
pain. The diagnosis was possible renal lithiasis. An IVP
(intravenous pyelogram) showed calcification in the pelvis,
most likely representing phlebolith. No calcification was
seen along the renal outlines. The test was determined to be
negative overall.
A September 1995 VA nephrology examination report noted the
veteran’s report of medications being Benadryl, Diazepam,
Elavil, and Capozide, and of his renal stone episodes in
1970, 1971, and 1983 or 1984. The veteran reported that he
had no complaints at that time. Upon physical examination
his blood pressure was found to be 132/86, his pulse was 98
and regular, and his respiration was 18 and non-labored. The
examiner noted that the specific evaluation was unremarkable.
The veteran reported no renal stones in the last eleven or
twelve years. The diagnosis was history of renal stones with
surgery.
Diagnosed disabilities of the genitourinary system are rated
in accordance with 38 C.F.R. § 4.115b, Diagnostic Codes (DC)
7500-7542. Where there is a question as to which of two
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates,
the criteria for the higher rating. 38 C.F.R. § 4.7 (1996).
The service connected renal lithiasis is currently rated by
analogy to DC 7509. Initially, the Board notes that DC 7508
is used to rate nephrolithiasis (renal lithiasis); however,
that code instructs to rate the disorder as hydronephrosis,
except for recurrent stone formation requiring one or more of
the following: diet therapy; drug therapy; or, invasive or
non- invasive procedures more than two times. This would
warrant a 30 percent rating. 38 C.F.R. § 4.115b, Diagnostic
Code 7508. There is no indication in any of the medical
evidence of record that these criteria are present.
Therefore, the veteran’s service-connected renal lithiasis
should be rated under DC 7509, hydronephrosis A 10 percent
rating contemplates hydronephrosis with only an occasional
attack of colic, with no infection and no catheter drainage.
The next higher rating of 20 percent contemplates frequent
attacks of colic, requiring catheter drainage. A 30 percent
contemplates frequent attacks of colic with infection
(pyonephrosis), and impaired kidney function. Ratings higher
than 30 percent are available for severe hydronephrosis and
are rated under the criteria for renal dysfunction. 38
C.F.R. § 4.115b, Diagnostic Code 7509. None of the criteria
warranting a rating in excess of that presently assigned have
been shown in the present case.
In every instance where the schedule does not provide a zero
percent evaluation for a diagnostic code, a zero percent
evaluation shall be assigned when the requirements for a
compensable evaluation are not met. 38 C.F.R. § 4.31 (1996).
In the present case, the most recent examination report
reveals no active renal disease process, and the veteran
reported no stones for approximately the preceding eleven or
twelve years. He also reported no complaints of pain or
other symptomatology during this examination. Accordingly,
the Board finds that the preponderance of the evidence
indicates that the veteran does not meet the compensable
criteria of DC 7509, and that his renal lithiasis is best
evaluated as noncompensable. See Butts v. Brown, 5 Vet.
App. 532, 539 (1993) (holding that the Board’s selection of a
diagnostic code may not be set aside as “arbitrary,
capricious, an abuse of discretion, or otherwise not in
accordance with the law,” if relevant data is examined and a
reasonable basis exists for its selection) (citations
omitted); see also Tedeschi v. Brown, 7 Vet. App. 411, 413-
14 (1995).
In reaching this decision the Board considered the doctrine
of reasonable doubt. However, as the preponderance of the
evidence is against the appellant’s claim, the doctrine is
not for application. Gilbert v. Derwinski, 1 Vet. App. 49
(1990).
The Board would point out that its denial of this issue is
based solely upon the provisions of the VA’s Schedule for
Rating Disabilities. In Floyd v. Brown, 9 Vet. App. 88, 96
(1996), the Court held that the Board does not have
jurisdiction to assign an extra-schedular evaluation pursuant
to the provisions of 38 C.F.R. § 3.321(b)(1) (1996) in the
first instance. In this case the evidence as a whole does
not reflect that the disability at issue has caused marked
interference with employment or presents such an exceptional
or unusual disability picture such as to render impractical
the application of the regular schedular standards which the
Board finds clearly contemplate the symptomatology
demonstrated. In view thereof, the Board is not required to
remand this matter to the RO for the procedural actions
outlined in 38 C.F.R. § 3.321(b)(1). See Bagwell v. Brown, 9
Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227
(1995).
ORDER
Entitlement to service connection for arthritis of multiple
joints is denied.
Entitlement to service connection for high blood pressure is
denied.
Entitlement to service connection for bilateral hearing loss
is denied.
Entitlement to an increased (compensable) evaluation for
renal lithiasis is denied.
S. L. KENNEDY
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1997), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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